Heart failure & cardiomyopathies
Combinations of diuretics for acute heart failure: a systematic review with network meta-analysis and trial sequential analysis
Authors' conclusion
Combination diuretic therapy improves short-term decongestion but does not reduce all-cause mortality, SAEs, hospital readmissions or kidney failure in patients with AHF.
Study context
- Population
- Patients with acute heart failure
- Participants
- 11,743 patients35 RCTs
- Comparison
- Diuretic combinations vs usual care
- Outcome
- All-cause mortality
Methodological detailstrial sequential analysis
- Trial sequential analysis
Pooled result
As reported in the abstract
- No diuretic combination influenced all-cause mortality (pairwise meta-analyses); Trial sequential analysis (TSA) showed no influence of combination therapy on mortality
Further pooled results
| Outcome | kg | P value |
|---|---|---|
| In-hospital body weight change (exploratory)Acetazolamide · I2=0.00% · aggregate data meta-analyses | −2.60 (95% CI −4.23 to −0.97) | P < 0.001 |
| In-hospital body weight change (exploratory)Thiazides · I2=38.53% · aggregate data meta-analyses | −0.80 (95% CI −1.40 to −0.21) | P = 0.01 |
| In-hospital body weight change (exploratory)Vaptans · I2=89.53% · aggregate data meta-analyses | −1.00 (95% CI −1.53 to −0.48) | P < 0.001 |
Serious adverse events (SAEs), hospital readmissions, kidney failure
- In pairwise meta-analyses, no diuretic influenced SAEs, hospital readmissions or kidney failure
In-hospital body weight change (exploratory)
- Network meta-analysis showed similar results; TSA: enough information to accept secondary diuretics influencing decongestion
Original publication
Combinations of diuretics for acute heart failure: a systematic review with network meta-analysis and trial sequential analysis. Heart. Published 13 November 2025. doi:10.
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